While millions of adults with chronic pain smoke, little is known about the associations between chronic pain and smoking cessation. Helping individuals with chronic pain to stop smoking is important in that pain- related outcomes are worse for smokers compared to nonsmokers with chronic pain. However, our preliminary data suggests that currently available smoking cessation interventions may not be effective for smokers with chronic pain, indicating the need for an intervention designed specifically for these individuals. The conceptual basis for this proposal is social cognitive theory. The primary aim of this research project is to develop a cognitive behavioral smoking cessation intervention for specific use in an outpatient clinical setting where smokers are receiving treatment for chronic pain. Secondary aims include examination of the mechanisms of change from baseline to end of treatment associated with the cognitive behavioral intervention based on our theoretical model, including self-efficacy, depression, pain-related affective distress, and pain-related anxiety. The project will be conducted in two phases. In Phase I, we will employ participatory research methods to develop a cognitive behavioral smoking cessation intervention for specific use in an outpatient practice environment for chronic pain. The participatory research methods will utilize informant interviews and focus groups involving individuals with chronic pain and health care providers with expertise in chronic pain and smoking cessation. This work will also involve development of a treatment manual, training of nurse counselors with expertise in smoking cessation and chronic pain, and pilot testing with 10 smokers. Phase 2 will consist of a clinical trial utilizing a randomized, two-group design with repeated assessment of smoking status at weeks 4 and 26. Smokers with chronic pain will be randomly assigned to receive the newly developed cognitive behavioral smoking cessation intervention (N = 30) or a brief smoking cessation intervention (N = 30), which is the current standard of care at our institution. The brief smoking cessation intervention was used in our preliminary study and no individual with chronic pain quit smoking. Self-report smoking cessation at weeks 4 and 26 will be biologically confirmed using a saliva cotinine kit. At project conclusion, the multidisciplinary team will have developed a smoking cessation intervention designed for dissemination to a general ambulatory population of smokers with chronic pain. PUBLIC HEALTH RELEVANCE: Millions of individuals with chronic pain smoke and our preliminary research suggest that currently available strategies to help people quit smoking may not be effective for individuals with chronic pain. This is important in that smokers with chronic pain have worse pain-related health outcomes compared to nonsmokers with chronic pain. The primary aim of this research project is to develop a smoking cessation intervention for specific use in an outpatient clinical setting for smokers with chronic pain.